Department of General Practice, University of Melbourne, Melbourne, Australia; Multidisciplinary Unit for Adolescent Health, Lausanne University Hospital, Lausanne, Switzerland.
Department of General Practice, University of Melbourne, Melbourne, Australia.
J Adolesc Health. 2017 Sep;61(3):302-309. doi: 10.1016/j.jadohealth.2017.03.015. Epub 2017 Jun 7.
The purpose of the study is to investigate whether a training intervention increases general practitioners' (GPs) detection sensitivity for probable mental disorders in young people.
Forty general practices were randomized to an intervention (29 GPs) or comparison arm (49 GPs). Intervention GPs participated in 9 hours of interactive training on youth-friendly care, psychosocial health risk screening, and responding to risk-taking behavior with motivational interviewing approaches, followed by practice visits assisting with integration of screening processes and tools. Youth aged 14-24 years attending GPs underwent a computer-assisted telephone interview about their consultation and psychosocial health risks. Having a "probable mental disorder" was defined as either scoring high on Kessler's scale of psychological distress (K10) or self-perceived mental illness. Other definitions tested were high K10; self-perceived mental illness; and high K10 and self-perceived mental illness. Psychosocial health risk screening rates, detection sensitivity, and other accuracy parameters (specificity, positive predictive value, and negative predictive value) were estimated.
GPs' detection sensitivity improved after the intervention if having probable mental disorder was defined as high K10 score and self-perceived mental illness (odds ratio: 2.81; 95% confidence interval: 1.23-6.42). There was no significant difference in sensitivity of GPs' detection for our preferred definition, high K10 or self-perceived mental illness (.37 in both; odds ratio: .93; 95% confidence interval: .47-1.83), and detection accuracy was comparable (specificity: .84 vs. .87, positive predictive values: .54 vs. .60, and negative predictive values: .72 vs. .72).
Improving recognition of mental disorder among young people attending primary care is likely to require a multifaceted approach targeting young people and GPs.
本研究旨在探讨培训干预是否能提高全科医生（GP）对年轻人疑似精神障碍的检测敏感度。
将 40 家全科诊所随机分为干预组（29 名 GP）和对照组（49 名 GP）。干预组的 GP 参加了 9 小时的互动培训，内容包括青年友好型护理、心理社会健康风险筛查以及使用动机式访谈方法应对冒险行为，随后进行实践访问，以协助整合筛查流程和工具。年龄在 14-24 岁之间的年轻人在接受 GP 看诊时，会接受关于他们咨询和心理社会健康风险的计算机辅助电话访谈。“疑似精神障碍”的定义是 Kessler 心理困扰量表（K10）得分较高或自我感知的精神疾病。测试的其他定义还包括高 K10 得分、自我感知的精神疾病以及高 K10 和自我感知的精神疾病。估计了心理社会健康风险筛查率、检测敏感度和其他准确性参数（特异性、阳性预测值和阴性预测值）。
如果将疑似精神障碍定义为高 K10 评分和自我感知的精神疾病，干预后 GP 的检测敏感度提高（优势比：2.81；95%置信区间：1.23-6.42）。对于我们首选的定义，即高 K10 或自我感知的精神疾病，GP 检测的敏感度没有显著差异（均为.37；优势比：.93；95%置信区间：.47-1.83），检测准确性也相当（特异性：.84 对.87，阳性预测值：.54 对.60，阴性预测值：.72 对.72）。
要提高初级保健中年轻人对精神障碍的识别率，可能需要针对年轻人和全科医生采取多方面的方法。
